MEDICARE: MS. KARLA MICHELLE MENDEZ LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M532513805460	OTHER	FL	DRIVERS LICENSE

General Provider Information

NPI Number	:	1891094587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARLA MICHELLE MENDEZ LMHC

Provider Business Mailing Address
First Line	:	8359 BEACON BLVD
Second Line	:	SUITE 311
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3048
Country	:	US
Telephone Number	:	239-425-2611
Fax Number	:	239-425-2610

Provider Business Practice Location Address
First Line	:	8359 BEACON BLVD
Second Line	:	SUITE 311
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3048
Country	:	US
Telephone Number	:	239-425-2611
Fax Number	:	239-425-2610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	05/22/2013

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